1
|
Kouka M, Brand S, Koscielny S, Bitter T, Pietschmann K, Ernst T, Guntinas-Lichius O. Role of Percutaneous Endoscopic Gastrostomy for the Nutrition of Head and Neck Cancer Patients before and up to 6 Months after Cancer Treatment. Cancers (Basel) 2024; 16:3138. [PMID: 39335110 PMCID: PMC11430239 DOI: 10.3390/cancers16183138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 09/03/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
This retrospective monocentric cohort study analyzed patients with head and neck cancer according their nutritional status and association of percutaneous endoscopic gastrostomy (PEG) from admission to six months after treatment at a tertiary hospital in Germany from 2017 to 2019. A total of 289 patients (76.5% men; median age 62 years; 63.3% stage IV) were included. Univariate analyses and ANOVAs with repeated measures were performed to analyze differences over time. The percentage of patients requiring PEG was 14.9% (43 of 289 patients) before start of treatment (Z0), 14% (40 of 286 patients alive) after one week (Z1), 22.7% (58 of 255 patients) after six weeks (Z2) and 23% (53 of 230 patients) after six months (Z3) from the end of treatment. PEG placement was associated with alcohol or nicotine consumption, in oropharyngeal and hypopharyngeal carcinoma, squamous cell carcinoma, cancer stage III/IV, chemotherapy and impairment of food intake (all p < 0.05). Weight loss between Z1 and Z3 with PEG did not differ from patients without PEG at Z0 (p = 0.074), although patients with PEG at Z0 had a lower mean weight at the beginning. PEG was important for a quarter of the patients alive at Z3 and helped to prevent weight loss.
Collapse
Affiliation(s)
- Mussab Kouka
- Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany
| | - Sophie Brand
- Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany
| | - Sven Koscielny
- Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany
| | - Thomas Bitter
- Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany
| | - Klaus Pietschmann
- Department of Radiation Oncology, Jena University Hospital, 07747 Jena, Germany
| | - Thomas Ernst
- University Tumor Center, Jena University Hospital, 07747 Jena, Germany
| | | |
Collapse
|
2
|
Bhatt N, Yang J, DeBaere L, Wang RS, Most A, Zhang Y, Dayanov E, Yang W, Santacatterina M, Kamberi M, Mojica J, Kamen E, Savitski J, Stein J, Jacobson A. Reducing Length of Stay in Reconstructive Head and Neck Surgery Patients: A Quality Improvement Initiative. Otolaryngol Head Neck Surg 2024. [PMID: 39118499 DOI: 10.1002/ohn.933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 06/14/2024] [Accepted: 06/24/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To investigate whether a new preoperative education and discharge planning protocol reduced unexpected discharge delays for patients undergoing reconstructive surgery for head and neck cancer. METHODS A quality improvement (QI) intervention was implemented in January 2021 with several components to address historically prolonged observed lengths of stay (LOS) with head and neck cancer patients. The intervention added a preoperative educational visit with a head and neck cancer advanced practice provider, a standardized preoperative speech and swallow assessment, a personalized patient care plan document, discussion of inpatient hospital stay expectations, and early discharge planning. The intervention group included patients who underwent the preoperative education protocol from February to December 2021. For comparison, an age and sex-matched control group was constructed from inpatients who had been admitted for similar procedures in the 2 years prior to the QI intervention (2019-2020) and received standard of care counseling. RESULTS Our study demonstrated a significant reduction in observed to expected LOS ratio after implementation of the intervention (1.24 ± 0.74 control, 0.95 ± 0.52 intervention; P = .012). DISCUSSION We discuss a preoperative education QI intervention at our institution. Our findings demonstrate that our intervention was associated with decreased LOS for patients undergoing head and neck reconstructive surgeries. IMPLICATIONS FOR PRACTICE This QI study shows the benefit of a new standardized preoperative education and discharge planning protocol for patients undergoing head and neck reconstructive surgeries.
Collapse
Affiliation(s)
- Nupur Bhatt
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Jackie Yang
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Lauren DeBaere
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Ronald Shen Wang
- New York University Grossman School of Medicine, New York City, New York, USA
| | - Allison Most
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Yan Zhang
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Elan Dayanov
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Wenqing Yang
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | | | - Maria Kamberi
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Jacqueline Mojica
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Emily Kamen
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Justin Savitski
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - John Stein
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Adam Jacobson
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| |
Collapse
|
3
|
Jovanovic N, Palma DA, Warner A, Mitchell S, Doyle PC, Theurer JA. Sarcopenia as a Predictor of Feeding Tube Placement in Individuals with Oropharyngeal Cancer. Adv Radiat Oncol 2024; 9:101484. [PMID: 38681896 PMCID: PMC11043844 DOI: 10.1016/j.adro.2024.101484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/14/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose In oropharyngeal squamous cell carcinoma (OPSCC), systemic loss of skeletal muscle mass (SMM), or sarcopenia, is a strong prognostic predictor of survival outcomes. However, the relationship between sarcopenia and nutrition-related outcomes is not well understood. This investigation evaluated the prognostic significance of sarcopenia for feeding tube (FT) placement in a cohort of OPSCC patients. Methods and Materials A retrospective cohort study was conducted with data collected from 194 OPSCC patients treated with definitive radiation therapy (RT) or chemoradiation therapy (CRT). Sarcopenia was assessed from computed tomography imaging at the level of the third cervical (C3) and fourth thoracic (T4) vertebrae. The prognostic nature of pretreatment sarcopenia and its relationship with FT placement was explored using logistic regression. Results The median age of patients included was 61.0 years, and the majority were male (83%). In this patient cohort, 87.6% underwent concurrent CRT, and 30.9% received a FT over the course of treatment. Sarcopenia was identified at baseline in 72.7% of patients based on C3 SMM measurements and in 41.7% based on measures at the level of T4. Based on measures at both C3 and T4, those with sarcopenia were significantly more likely to receive a FT and had significantly worse freedom from FT placement compared with patients without sarcopenia. Sarcopenia assessed at T4 was a significant predictor of FT placement. Conclusions SMM measured at T4 may represent a novel and practical biomarker for sarcopenia detection that is associated with the need for FT placement. These findings suggest that the detection of baseline sarcopenia could guide decision-making related to the need for nutritional support in OPSCC patients undergoing RT/CRT.
Collapse
Affiliation(s)
| | - David A. Palma
- Department of Radiation Oncology, London Health Science Centre, London, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Science Centre, London, Canada
| | - Sylvia Mitchell
- Department of Radiation Oncology, London Health Science Centre, London, Canada
| | - Philip C. Doyle
- Department of Otolaryngology – Head and Neck Surgery, Division of Laryngology, Stanford University School of Medicine, Stanford, California
| | - Julie A. Theurer
- Health and Rehabilitation Sciences, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
- Department of Otolaryngology – Head and Neck Surgery, London Health Science Centre, London, Canada
- School of Communication Sciences and Disorders, Elborn College, Western University, London, Canada
| |
Collapse
|
4
|
Parham MJ, Ding Y, Wang DS, Jiang AY, Buchanan EP. Pediatric Craniofacial Tumor Reconstruction. Semin Plast Surg 2023; 37:265-274. [PMID: 38098683 PMCID: PMC10718654 DOI: 10.1055/s-0043-1776330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Effective management of pediatric craniofacial tumors requires coordinated input from medical, oncologic, and surgical specialties. Reconstructive algorithms must consider limitations in pediatric donor tissue and account for future growth and development. Immediate reconstruction is often focused on filling dead space, protecting underlying structures, and ensuring skeletal symmetry. Staged reconstruction occurs after the patient has reached skeletal maturity and is focused on restoring permanent dentition. Reconstructive options vary depending on the location, size, and composition of resected tissue. Virtual surgical planning (VSP) reduces the complexity of pediatric craniofacial reconstruction and ensures more predictable outcomes.
Collapse
Affiliation(s)
- Matthew J. Parham
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Yang Ding
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Daniel S. Wang
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Austin Y. Jiang
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Edward P. Buchanan
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Austin, Texas
| |
Collapse
|
5
|
Lu CH, Hsu CC, Su PH, Lin SY, Yeh KY, Hsueh SW, Chang JTC, Wang HM, Hung YS, Chou WC. Effect of prophylactic tube feeding in head and neck cancer patients with high Mallampati score undergoing definitive concurrent chemoradiotherapy. Support Care Cancer 2023; 31:384. [PMID: 37289404 DOI: 10.1007/s00520-023-07859-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 06/01/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE There is no consensus on the selection of appropriate prophylactic tube feeding in patients with head and neck squamous cell carcinoma (HNSCC) undergoing concurrent chemoradiotherapy (CCRT). This study aimed to evaluate the effect of prophylactic tube feeding in patients with HNSCC who presented with a high Mallampati score and underwent CCRT. METHODS We prospectively enrolled 185 consecutive patients with stage II to IVa HNSCC and a pre-treatment Mallampati score of 3 or 4 who received CCRT between August 2017 and December 2018 with follow-up data collected retrospectively. Patients were divided to either with or without prophylactic tube feeding group for comparison of treatment tolerance, toxicities, and quality of life(QOL). Propensity score matching (PSM) was used to achieve balanced covariates across the two groups. RESULTS Of the cohort, 52 (28.1%) and 133 (71.9%) patients were allocated to the prophylactic and non-prophylactic tube feeding groups, respectively. Before and after PSM, patients in the tube feeding group had a significantly lower incidence of incomplete radiotherapy, incompletion of chemotherapy, emergency room visits, and grade 3 or higher infection, and improved symptoms of quality of life after CCRT than those in the non-tube feeding group. CONCLUSION Prophylactic tube feeding was associated with better treatment tolerance, safety profiles, and quality of life in patients with HNSCC and high Mallampati scores who underwent CCRT. Therefore, Mallampati score might serve as a clinical tool for proactive selection of patients receiving prophylactic tube feeding in HNSCC patients upon receiving CCRT.
Collapse
Affiliation(s)
- Chang-Hsien Lu
- Department of Hematology-Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
| | - Chih-Chung Hsu
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, and Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Po-Hsu Su
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Shinn-Yn Lin
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, and Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Kun-Yun Yeh
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Shun-Wen Hsueh
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Joseph Tung-Chieh Chang
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, and Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hung-Ming Wang
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, and Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yu-Shin Hung
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, and Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Wen-Chi Chou
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan.
- Departments of Hematology-Oncology, and Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
| |
Collapse
|
6
|
Alexidis P, Kolias P, Mentesidou V, Topalidou M, Kamperis E, Giannouzakos V, Efthymiadis K, Bangeas P, Timotheadou E. Investigating Predictive Factors of Dysphagia and Treatment Prolongation in Patients with Oral Cavity or Oropharyngeal Cancer Receiving Radiation Therapy Concurrently with Chemotherapy. Curr Oncol 2023; 30:5168-5178. [PMID: 37232849 DOI: 10.3390/curroncol30050391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/20/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
Radiation therapy (RT) treatment for head and neck cancer has been associated with dysphagia manifestation leading to worse outcomes and decrease in life quality. In this study, we investigated factors leading to dysphagia and treatment prolongation in patients with primaries arising from oral cavity or oropharynx that were submitted to radiation therapy concurrently with chemotherapy. The records of patients with oral cavity or oropharyngeal cancer that received RT treatment to the primary and bilateral neck lymph nodes concurrently with chemotherapy were retrospectively reviewed. Logistic regression models were used to analyze the potential correlation between explanatory variables and the primary (dysphagia ≥ 2) and secondary (prolongation of total treatment duration ≥ 7 days) outcomes of interest. The Toxicity Criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) were used to evaluate dysphagia. A total of 160 patients were included in the study. Age mean was 63.31 (SD = 8.24). Dysphagia grade ≥ 2 was observed in 76 (47.5%) patients, while 32 (20%) experienced treatment prolongation ≥ 7 days. The logistic regression analysis showed that the volume in the primary site of disease that received dose ≥ 60 Gy (≥118.75 cc, p < 0.001, (OR = 8.43, 95% CI [3.51-20.26]) and mean dose to the pharyngeal constrictor muscles > 40.6 Gy (p < 0.001, OR = 11.58, 95% CI [4.84-27.71]) were significantly associated with dysphagia grade ≥ 2. Treatment prolongation ≥ 7 days was predicted by higher age (p = 0.007, OR = 1.079, 95% CI [1.021-1.140]) and development of grade ≥ 2 dysphagia (p = 0.005, OR = 4.02, 95% CI [1.53-10.53]). In patients with oral cavity or oropharyngeal cancer that receive bilateral neck irradiation concurrently with chemotherapy, constrictors mean dose and the volume in the primary site receiving ≥ 60 Gy should be kept below 40.6 Gy and 118.75 cc, respectively, whenever possible. Elderly patients or those that are considered at high risk for dysphagia manifestation are more likely to experience treatment prolongation ≥ 7 days and they should be closely monitored during treatment course for nutritional support and pain management.
Collapse
Affiliation(s)
- Petros Alexidis
- Radiation Oncologist, Department of Radiation Oncology, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Pavlos Kolias
- Section of Statistics and Operational Research, Department of Mathematics, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece
| | - Vaia Mentesidou
- Medical Oncology Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Maria Topalidou
- Radiation Oncologist, Department of Radiation Oncology, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Efstathios Kamperis
- Radiation Oncologist, Department of Radiation Oncology, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Vasileios Giannouzakos
- Radiation Oncologist, Department of Radiation Oncology, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Konstantinos Efthymiadis
- Medical Oncology Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Petros Bangeas
- 1st University Surgery Department, Nanomedicine and Nanotechnology Aristotle University of Thessaloniki, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Eleni Timotheadou
- Medical Oncologist, Medical Oncology Clinic Aristotle University of Thessaloniki, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| |
Collapse
|
7
|
Ghosh Laskar S, Sinha S, Gupta M, Karmakar S, Nivedha J M, Kannan S, Budrukkar A, Swain M, Kumar A, Gupta T, Murthy V, Chaukar D, Pai P, Chaturvedi P, Pantvaidya G, Nair D, Nair S, Thiagarajan S, Deshmukh A, Noronha V, Patil V, Joshi A, Prabhash K, Agarwal JP. Prophylactic versus reactive feeding approach in patients undergoing adjuvant radiation therapy for oral cavity squamous cell carcinoma: A propensity score matched-pair analysis. Head Neck 2023; 45:1226-1236. [PMID: 36912016 DOI: 10.1002/hed.27336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/18/2023] [Accepted: 02/27/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND To assess the efficacy of prophylactic versus reactive feeding strategy in oral cavity squamous cell carcinoma (OCSCC) patients receiving adjuvant radiation therapy (RT). METHODS This was a post hoc analysis of patients of OCSCC enrolled in a randomized trial comparing three adjuvant strategies. In this trial, till 2010, a prophylactic feeding approach was followed for all patients. Since January 2011, a reactive feeding approach was followed. RESULTS Two hundred and sixty-eight in each cohort (total n = 526) were eligible for analysis after propensity score matching. At 6 weeks post-RT completion, the median weight loss in the prophylactic versus reactive cohort was 5 versus 3 kg, p = 0.002. At all other time points until 1 year, the median weight loss was lesser in reactive than in the prophylactic cohort. CONCLUSIONS A reactive feeding tube approach should be preferred for OCSCC receiving adjuvant RT.
Collapse
Affiliation(s)
- Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shwetabh Sinha
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Meetakshi Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shreyasee Karmakar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Meenakshi Nivedha J
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sadhana Kannan
- Clinical Research Secretariat, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anuj Kumar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Devendra Chaukar
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prathamesh Pai
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gouri Pantvaidya
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Deepa Nair
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sudhir Nair
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shivakumar Thiagarajan
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anuja Deshmukh
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| |
Collapse
|
8
|
Ma SJ, Iovoli AJ, Wang K, Neimanis D, Smith KA, Attwood K, Farrugia M, Hermann G, Singh AK. Efficacy of Prophylactic High-Dose Gabapentin and Venlafaxine on Reducing Oral Mucositis Pain Among Patients Treated With Chemoradiation for Head and Neck Cancer: A Single-Institution, Phase 2, Randomized Clinical Trial. Int J Radiat Oncol Biol Phys 2023:S0360-3016(23)00084-6. [PMID: 36736633 DOI: 10.1016/j.ijrobp.2023.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/11/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Given the paucity of level 1 evidence, the optimal regimen to control oral mucositis pain remains unclear. Although national guidelines allow consideration of prophylactic gabapentin, prior trials showed improved pain control with venlafaxine among patients with diabetic neuropathy. We sought to investigate the role of prophylactic high-dose gabapentin with venlafaxine to reduce oral mucositis pain among patients with head and neck cancer. METHODS AND MATERIALS We performed a single-institution, phase 2 randomized trial on nonmetastatic squamous cell carcinoma of the head and neck treated with chemoradiation. Patients were randomized to either prophylactic gabapentin (3600 mg daily) with or without venlafaxine (150 mg daily). Primary endpoint was differences in pain levels at the end of chemoradiation. Secondary endpoint was toxicity profiles, quality of life changes, opioid use, and feeding tube placement. Differences between the 2 arms at multiple time points were evaluated using a generalized linear mixed regression model with Sidak correction. RESULTS Between May 2018 and March 2021, a total of 62 patients were enrolled and evaluable for analysis (n = 32 for the gabapentin alone arm, n = 30 for the gabapentin + venlafaxine arm). Over 90% of patients tolerated gabapentin well. Head and neck pain level showed a mean value of 45 (standard deviation, 23) and 43 (standard deviation, 21) for the gabapentin alone and the gabapentin + venlafaxine arms, respectively (P = .65). No statistically significant differences were observed in adverse events, opioid use, feeding tube placement, or quality of life. CONCLUSIONS The addition of venlafaxine to prophylactic gabapentin did not result in improvements in pain control and quality of life among patients with head and neck cancer.
Collapse
Affiliation(s)
- Sung Jun Ma
- Departments of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Austin J Iovoli
- Departments of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Katy Wang
- Departments of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Debbie Neimanis
- Departments of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kelsey A Smith
- Departments of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kristopher Attwood
- Departments of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Mark Farrugia
- Departments of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Gregory Hermann
- Department of Radiation Oncology, OSF Healthcare Saint Francis Medical Center, University of Illinois College of Medicine at Peoria, Peoria, Illinois
| | - Anurag K Singh
- Departments of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York.
| |
Collapse
|
9
|
Din-Lovinescu C, Barinsky GL, Povolotskiy R, Grube JG, Park CW. Percutaneous Endoscopic Gastrostomy Tube Timing in Head and Neck Cancer Surgery. Laryngoscope 2023; 133:109-115. [PMID: 35366010 PMCID: PMC10084390 DOI: 10.1002/lary.30127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/27/2022] [Accepted: 03/21/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine outcomes and complications in patients receiving a percutaneous endoscopic gastrostomy (PEG) tube on the same day of head and neck cancer (HNC) surgery versus later in hospitalization. METHODS The 2003-2014 Nationwide Inpatient Sample was queried for patients undergoing ablative HNC procedures who had a PEG tube placed. Cases were stratified by PEG tube timing into an early (on the same day as ablative procedure) and late (later in hospitalization) group. Demographics and outcomes were compared using univariate analysis and multivariate regression modeling. RESULTS A total of 4,068 cases were included, of which 2,206 (54.23%) underwent early PEG and 1,862 (45.77%) received a late PEG tube. Late PEG tube patients were more likely to have a diagnosis of malnutrition (18.0% vs. 15.3%, p = 0.018) or renal failure (4.7% vs. 3.0%, p = 0.006). On multivariate regression analysis, patients receiving late PEG tubes were more likely to experience aspiration pneumonia, acute pulmonary disease, infectious pneumonia, sepsis, hematoma, wound disruption, surgical site infection, and fistula formation (all p < 0.05). The mean length of stay and hospital charges in the late PEG group were significantly greater (17.1 vs. 12.6 days, p < 0.001) and ($159,993 vs. $125,705, p < 0.001), respectively. CONCLUSIONS Patients undergoing HNC surgery who received a PEG tube on the day of ablative surgery had lower complication rates, shorter length of stay, and decreased hospital costs compared to those who had a PEG tube placed later during hospitalization. Further research is needed to determine the causal relationships behind these findings. LEVEL OF EVIDENCE 3 Laryngoscope, 133:109-115, 2023.
Collapse
Affiliation(s)
- Corina Din-Lovinescu
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Gregory L Barinsky
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Roman Povolotskiy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jordon G Grube
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Chan W Park
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| |
Collapse
|
10
|
Kao DD, Ferrandino RM, Bauml JM, Marshall DC, Bakst R, Roof S, Park YHA, Sigel KM. Prophylactic feeding tube placement for squamous cell carcinoma of the head and neck. Oral Oncol 2022; 135:106216. [PMID: 36326521 PMCID: PMC10363279 DOI: 10.1016/j.oraloncology.2022.106216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/14/2022] [Accepted: 10/11/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastronomy (PEG) tubes are commonly used to administer enteral nutrition during head and neck cancer (HNC) treatment. However, the benefits of placing a prophylactic feeding tube (PFT; prior to radiotherapy [RT]) or reactive feeding tube (RFT, after RT initiation) are unclear. We sought to compare survival, body mass trends, and hospitalization rates between strategies. METHODS We conducted a retrospective cohort study of 11,473 Veterans with stages III-IVC HNC treated with chemoradiotherapy. Patients with PEG tube placement within 30 days prior to treatment initiation (PFT) were compared to all other patients (non-PFT) or patients with PEG tube placement within 3 months after treatment initiation placement (RFT). We compared survival, longitudinal body mass changes, and hospitalization rates for PFT versus non-PFT or RFT patients in propensity score (PS)-matched Cox regression models. RESULTS 3,186 (28 %) patients received PFT and 8,287 (72 %) were non-PFT, of which 1,874 (23 %) received RFT. After PS-matching, there were no significant differences in overall survival (HR 0.97, 95 % CI 0.92-1.02), HNC-specific survival (HR 0.98, 95 % CI 0.92-1.09), change in BMI (p = 0.24), or hospitalization rates between PFT and non-PFT groups. Significant differences in hospitalization rates between PFT and RFT groups persisted after PS-matching (-0.11 hospitalizations/month), but no differences were found for other outcomes. CONCLUSION Timing of PEG tube placement in Veterans with HNC was not associated with any significant survival or body mass advantage. However, patients who received PFT had a lower hospitalization rate than those who received RFT.
Collapse
Affiliation(s)
- Derek D Kao
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rocco M Ferrandino
- Deparment of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua M Bauml
- Department of Medicine, Division of Hematology/Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Scott Roof
- Deparment of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yeun-Hee A Park
- Department of Medicine, Division of Hematology/Oncology, James J. Peters VA Medical Center, Bronx, NY, USA; Department of Medicine, Division of Hematology/Oncology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Keith M Sigel
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
11
|
Coke A, Gilbert M, Hill S, Siddiqui F. Nasogastric Feeding Tube/Dobhoff Placement: A Multidisciplinary Approach to the Management of Malnutrition During Radiation Therapy in Patients With Head and Neck Cancer. Cureus 2022; 14:e24905. [PMID: 35698672 PMCID: PMC9186100 DOI: 10.7759/cureus.24905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/05/2022] Open
|
12
|
Effect of prophylactic gastrostomy on nutritional and clinical outcomes in patients with head and neck cancer. Eur J Clin Nutr 2022; 76:1536-1541. [PMID: 35534701 DOI: 10.1038/s41430-022-01154-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aimed to identify which enteral feeding method was most beneficial for patients and compare clinical outcomes, quality of life, and complication rates by assessing patients who underwent prophylactic percutaneous endoscopic gastrostomy (pPEG) tube, reactive percutaneous endoscopic gastrostomy (rPEG) tube or reactive nasogastric tube (rNGT) insertion. METHODS Patients with head and neck cancers (HNCs) were enrolled between April 1, 2013 and April 17, 2019 (n = 335; 296 males, 39 females). Data concerning patient characteristics and treatment modalities were extracted from the medical records. Comparisons between enteral feeding methods were made by univariate and multivariate analysis. Overall survival (OS) outcomes were analyzed by the log rank test using the Kaplan-Meier method. RESULTS A total of 335 patients were included. The median follow-up time was 29.5 months. There were forty-six patients in the pPEG tube group, 23 patients in the rPEG tube group, and 266 patients in the rNGT group. pPEG, increased body-mass index (BMI), and N0-1 category were significantly associated with less weight loss in the multivariate analysis (all P < 0.05). pPEG decreased the rate of radiotherapy delay compared with that of reactive interventions (23.1% vs. 47.1%, P = 0.007). In terms of quality of life, global health status, role functioning, emotional functioning, cognitive functioning, pain, and dyspnea were significantly improved in the pPEG tube group (all P < 0.05). BMI and weight loss were independent prognostic factors for clinical survival outcomes (all P < 0.05). CONCLUSIONS pPEG could improve nutrition outcomes, reduce treatment delay, and maintain quality of life.
Collapse
|
13
|
Rajan A, Wangrattanapranee P, Kessler J, Kidambi TD, Tabibian JH. Gastrostomy tubes: Fundamentals, periprocedural considerations, and best practices. World J Gastrointest Surg 2022; 14:286-303. [PMID: 35664365 PMCID: PMC9131834 DOI: 10.4240/wjgs.v14.i4.286] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/09/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
Gastrostomy tube placement is a procedure that achieves enteral access for nutrition, decompression, and medication administration. Preprocedural evaluation and selection of patients is necessary to provide optimal benefit and reduce the risk of adverse events (AEs). Appropriate indications, contraindications, ethical considerations, and comorbidities of patients referred for gastrostomy placement should be weighed and balanced. Additionally, endoscopist should consider either a transoral or transabdominal approach is appropriate, and radiologic or surgical gastrostomy tube placement is needed. However, medical history, physical examination, and imaging prior to the procedure should be considered to tailor the appropriate approach and reduce the risk of AEs.
Collapse
Affiliation(s)
- Anand Rajan
- Department ofGastroenterology, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
- Department ofGastroenterology, City of Hope Medical Center, Duarte, CA 91010, United States
| | | | - Jonathan Kessler
- Department ofInterventional Radiology, City of Hope Medical Center, Duarte, CA 91010, United States
| | - Trilokesh Dey Kidambi
- Department ofGastroenterology, City of Hope Medical Center, Duarte, CA 91010, United States
| | - James H Tabibian
- Department ofGastroenterology, UCLA-Olive View Medical Center, Sylmar, CA 91342, United States
| |
Collapse
|
14
|
Bossola M, Antocicco M, Pepe G. Tube feeding in head and neck cancer patients undergoing chemoradiotherapy: a systematic review. JPEN J Parenter Enteral Nutr 2022; 46:1258-1269. [PMID: 35244947 DOI: 10.1002/jpen.2360] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/03/2022] [Accepted: 02/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Head and neck cancer patients are frequently malnourished at the time of diagnosis and prior to the beginning of treatment. In addition, chemo-radiotherapy (CRT) causes or exacerbates symptoms, such as alteration or loss of taste, mucositis, xerostomia, fatigue, nausea, and vomiting, with consequent worsening of malnutrition. If obstructing cancer and/or mucositis interfere with swallowing, enteral nutrition should be delivered by a nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG). AIM To revise the studies comparing NGT and PEG in terms of nutritional outcomes, survival, hospitalizations, number of interruptions of radiotherapy, quality of life, swallowing function. RESULTS A total of 250 publications were identified via electronic databases. After screening the titles, abstracts and full texts, 26 manuscripts that met the inclusion criteria were included for analysis. We divided the analysis in two sections: 1) comparison of enteral nutrition through NGT or PEG and 2) comparison of reactive PEG (R-PEG) and prophylactic PEG (P-PEG). RESULTS Both PEG and NGT are an effective method of providing nutritional support during chemoradiotherapy for head and neck cancer. They are essentially comparable in terms of nutritional outcomes, number of radiotherapy interruptions, survival, and quality of life, whereas swallow function seems better with NGT. PEG may be associated with major complications such as exit site infection, malfunction, leakage, pain, and pulmonary infection and higher costs. Nevertheless, NGT dislodged more often, patients find it more inconvenient, may cause aspiration pneumonia and PEG has advantages over NGT of enhanced mobility and improved cosmesis. P-PEG and R-PEG are essentially similar in terms of nutritional outcomes, number of interruptions of radiotherapy, and survival. Conflicting results have been reported about quality of life. CONCLUSION PEG is not better than NGT in terms of nutritional, oncologic, and quality of life outcomes. Prophylactic feeding through NGT or PEG, compared to reactive feeding, does not offer significant advantages in terms of nutritional outcomes, interruptions of radiotherapy and survival. However, the number of prospective randomized studies on this topic is much limited and consequently definitive conclusions cannot be drawn. Overall, it seems that further adequate prospective, randomized studies are needed to define the better nutritional intervention in head and neck cancer patients undergoing chemoradiotherapy. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Maurizio Bossola
- Dipartimento di Scienze Mediche e Chirurgiche, Policlinico Universitario Fondazione Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore
| | - Manuela Antocicco
- Dipartimento di Scienze dell'invecchiamento, neurologiche, ortopediche e della testa-collo, Policlinico Universitario Fondazione Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore
| | - Gilda Pepe
- Dipartimento di Scienze Mediche e Chirurgiche, Policlinico Universitario Fondazione Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore
| |
Collapse
|
15
|
Thirayan V, Jameson MB, Gregor RT. Prophylactic versus reactive percutaneous endoscopic gastrostomy in oropharyngeal squamous cell carcinoma patients undergoing radical radiotherapy. ANZ J Surg 2021; 91:2720-2725. [PMID: 34427036 DOI: 10.1111/ans.17159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 07/06/2021] [Accepted: 08/03/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Radiotherapy (RT) for oropharyngeal squamous cell cancer (OPSCC) is associated with malnutrition due to treatment-related mucositis and dysphagia. While percutaneous endoscopic gastrostomy (PEG) feeding can improve nutrition, it has acute and late complications, including dependence on PEG feeding. We retrospectively evaluated patient outcomes by whether gastrostomy placement was prophylactic (P-G) or reactive to RT complications (R-G). METHODS Retrospective analysis of OPSCC patients undergoing curative-intent RT at Waikato Hospital between 2010 and 2015. RESULTS Of 103 OPSCC patients treated with RT (+/- chemotherapy) 21 had P-G, 15 had R-G and 67 had none (No-G). P-G patients were significantly more likely to be female, older, have higher tumour stage and receive bilateral RT (all p < 0.05). P-G and No-G patients had similar rates and duration of hospital admission for complications during treatment, but both were significantly less than in R-G patients (admission rates 52.3%, 49.3% and 86.7%, and mean length of stay 3.5, 3.3 and 11.9 days, respectively; p < 0.001). R-G patients also had greater RT treatment delays than P-G or No-G patients (mean 1.1, 0.7 and 0.4 days, respectively, p < 0.05). No significant differences were noted between groups in PEG dependence or weight change during, or 1, 3 or 6 months after, RT. Weight loss was not significantly different with P-G than R-G despite more frequent use of bilateral RT fields in the former group. CONCLUSIONS P-G placement affords shorter and less frequent hospital admissions than R-G during RT for OPSCC, with no increased complications or gastrostomy-dependence rates.
Collapse
Affiliation(s)
- Varun Thirayan
- Resident Medical Officer Unit, Waikato Hospital, Hamilton, New Zealand
| | - Michael Barrett Jameson
- Oncology Department, Waikato Hospital, Hamilton, New Zealand.,Waikato Clinical Campus, Faculty of Medical and Health Sciences, University of Auckland, Hamilton, New Zealand
| | | |
Collapse
|
16
|
Predictors of the need for prophylactic percutaneous endoscopic gastrostomy in head and neck cancer patients treated with concurrent chemoradiotherapy. Int J Clin Oncol 2021; 26:1179-1187. [PMID: 34086112 DOI: 10.1007/s10147-021-01889-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/11/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND We investigated whether prophylactic percutaneous endoscopic gastrostomy (PEG) is used effectively for patients treated with definitive concurrent chemoradiotherapy (CCRT) and the predictors of the need for PEG. METHODS 326 patients with laryngeal, oropharyngeal or hypopharyngeal cancers were retrospectively reviewed. RESULTS The PEG tube use group had more favorable results than the total parenteral nutrition and nasogastric tube groups in terms of rate of serum albumin loss, incidence of severe fever and aspiration pneumonia, CCRT completion rate and hospitalization period. However, it was inferior to oral intake. Analysis of the relative risk of requiring enteral or parenteral nutrition revealed that performance status (PS) 2, primary site (supraglottis, oropharynx, or hypopharynx), N3 disease, and cisplatin were predictors of the need for nutritional support. CONCLUSIONS Prophylactic PEG is effective for patients treated with definitive CCRT and is especially required for patients with PS2 or oropharyngeal cancer.
Collapse
|
17
|
Rivers CI, Iovoli AJ, Chatterjee U, Hermann GM, Singh AK. Intravenous fluids for pain management in head and neck cancer patients undergoing chemoradiation. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:912. [PMID: 34164546 PMCID: PMC8184454 DOI: 10.21037/atm-20-3910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Pain due to oral mucositis affects the majority of patients receiving chemoradiation (CRT) for head and neck cancer (HNC), and often results in dehydration. Anecdotally, intravenous (IV) fluids administered during treatment for the resultant dehydration was found to alleviate this pain. The purpose of this retrospective study was to evaluate the effectiveness of IV fluids as a method pain management in this patient population. Methods Patients with oral mucositis pain, secondary to CRT for HNC, were given IV fluids according to standard clinic protocol. Patients were evaluated using orthostatic vital signs and prospectively surveyed pre- and post-IV fluid administration, which included the Visual Analog Scale (VAS) for pain. Difference in pain pre- and post-IV fluid administration was evaluated using a two-tailed paired Student’s t-test. Results Twenty-four patients with a total of 31 fluid administrations was available for analysis. Twenty-three patients were receiving or had recently completed CRT. One patient was receiving radiation alone. Six instances of fluid administration were excluded due to: refusal to complete the survey, concurrent pulmonary embolism, concurrent pain medication, and drug seeking behavior. Average pain score decreased from 6.5 [standard deviation (SD) 2.1] prior to IV fluids to 4.0 (SD 2.4) following fluid administration (P<0.001). Conclusions To our knowledge, this is the first report directly correlating IV fluid administration with pain relief, even in the absence of orthostasis. Our findings indicate that in patients undergoing CRT for HNC, the use of IV fluids alone was effective in acutely and significantly reducing pain secondary to oral mucositis.
Collapse
Affiliation(s)
- Charlotte I Rivers
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA.,Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Austin J Iovoli
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Udit Chatterjee
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Gregory M Hermann
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA.,Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Anurag K Singh
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA.,Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| |
Collapse
|
18
|
Judge LF, Farrugia MK, Singh AK. Narrative review of the management of oral mucositis during chemoradiation for head and neck cancer. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:916. [PMID: 34164550 PMCID: PMC8184418 DOI: 10.21037/atm-20-3931] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/31/2020] [Indexed: 12/31/2022]
Abstract
Oral mucositis (OM) can be a significant problem for patients undergoing radiation or chemoradiation for head and neck cancer. In modern clinical trials, grade 3-4 OM can be seen in over 40% of patients and can cause a significant impact on their quality of life (QOL). Despite this fact, strategies for the prevention and treatment of OM vary widely, with options including both lifestyle modifications and pharmaceuticals. Here we evaluate and summarize the current clinical interventions for the management of radiation-induced OM. The majority of the current evidence focuses on reducing OM related pain. These agents are detailed over multiple clinical trials including treatment modalities such as: GC4419, doxepin mouthwash, diphenhydramine-lidocaine-antacid (DLA) mouthwash, gabapentin, and methadone. While several strategies have been employed to prevent radiation-induced OM, there is currently no strong evidence for the routine use of these agents in the clinic. After summarization of these treatments, we offer practical guidance for the treatment of OM in the clinic. We recommend a multiagent approach of pharmacological and non-pharmacological treatments including oral rinses, home humidification, escalating doses of gabapentin, doxepin or DLA mouthwash, over the counter analgesics, and lastly methadone. These interventions are tailored to address the expected increase of severity of symptoms during the course of head and neck radiotherapy.
Collapse
Affiliation(s)
- Lauren F. Judge
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Mark K. Farrugia
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Anurag K. Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| |
Collapse
|
19
|
Nutritional Support in Head and Neck Radiotherapy Patients Considering HPV Status. Nutrients 2020; 13:nu13010057. [PMID: 33375430 PMCID: PMC7823874 DOI: 10.3390/nu13010057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 02/07/2023] Open
Abstract
Malnutrition is a common problem in patients with head and neck cancer (HNC), including oropharyngeal cancer (OPC). It is caused by insufficient food intake due to dysphagia, odynophagia, and a lack of appetite caused by the tumor. It is also secondary to the oncological treatment of the basic disease, such as radiotherapy (RT) and chemoradiotherapy (CRT), as a consequence of mucositis with the dry mouth, loss of taste, and dysphagia. The severe dysphagia leads to a definitive total impossibility of eating through the mouth in 20–30% of patients. These patients usually require enteral nutritional support. Feeding tubes are a commonly used nutritional intervention during radiotherapy, most frequently percutaneous gastrostomy tube. Recently, a novel HPV-related type of OPC has been described. Patients with HPV-associated OPC are different from the HPV− ones. Typical HPV− OPC is associated with smoking and alcohol abuse. Patients with HPV+ OPC are younger and healthy (without comorbidities) at diagnosis compared to HPV− ones. Patients with OPC are at high nutritional risk, and therefore, they require nutritional support in order to improve the treatment results and quality of life. Some authors noted the high incidence of critical weight loss (CWL) in patients with HPV-related OPC. Other authors have observed the increased acute toxicities during oncological treatment in HPV+ OPC patients compared to HPV− ones. The aim of this paper is to review and discuss the indications for nutritional support and the kinds of nutrition, including immunonutrition (IN), in HNC, particularly OPC patients, undergoing RT/CRT, considering HPV status.
Collapse
|
20
|
Bojaxhiu B, Shrestha BK, Luterbacher P, Elicin O, Shelan M, Macpherson AJS, Heimgartner B, Giger R, Aebersold DM, Zaugg K. Unplanned hospitalizations in patients with locoregionally advanced head and neck cancer treated with (chemo)radiotherapy with and without prophylactic percutaneous endoscopic gastrostomy. Radiat Oncol 2020; 15:281. [PMID: 33317602 PMCID: PMC7737384 DOI: 10.1186/s13014-020-01727-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/06/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Current studies about percutaneous endoscopic gastrostomy (PEG) tube placement report equivalent patient outcomes with prophylactic PEG tubes (pPEGs) versus common nutritional support. Unreported was if omitting a pPEG is associated with an increased risk of complications leading to a treatment-related unplanned hospitalization (TRUH). METHODS TRUHs were retrospectively analyzed in patients with advanced head and neck squamous cell carcinoma (n = 310) undergoing (chemo)radiotherapy with (pPEG) or without PEG (nPEG). RESULTS In 88 patients (28%), TRUH was reported. One of the leading causes of TRUH in nPEG patients was inadequate oral intake (n = 16, 13%), and in pPEG patients, complications after PEG tube insertion (n = 12, 10%). Risk factors for TRUH were poor performance status, tobacco use, and surgical procedures. CONCLUSIONS Omitting pPEG tube placement without increasing the risk of an unplanned hospitalization due to dysphagia, dehydration or malnutrition, is an option in patients being carefully monitored. Patients aged > 60 years with hypopharyngeal carcinoma, tobacco consumption, and poor performance status appear at risk of PEG tube-related complications leading to an unplanned hospitalization.
Collapse
Affiliation(s)
- Beat Bojaxhiu
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Radiation Oncology, Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zurich, Switzerland
| | - Binaya K Shrestha
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascal Luterbacher
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew J S Macpherson
- Department of Visceral Surgery and Medicine, Division of Gastroenterology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Benjamin Heimgartner
- Department of Visceral Surgery and Medicine, Division of Gastroenterology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kathrin Zaugg
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. .,Department of Radiation Oncology, Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zurich, Switzerland.
| |
Collapse
|
21
|
An Analysis and Comparison of Survival and Functional Outcomes in Oropharyngeal Squamous Cell Carcinoma Patients Treated with Concurrent Chemoradiation Therapy within City of Hope Cancer Center Sites. J Clin Med 2020; 9:jcm9103083. [PMID: 32987866 PMCID: PMC7601157 DOI: 10.3390/jcm9103083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 12/02/2022] Open
Abstract
Oropharyngeal squamous cell carcinoma (OPSCC) is a subset of head and neck cancers that can arise due to human papillomavirus (HPV) infection. We designed a retrospective analysis to determine differences in outcomes of OPSCC patients treated at City of Hope (COH) Cancer Center’s main campus versus selected satellite sites with COH-associated faculty and facilities. Patients diagnosed with OPSCC and treated with concurrent chemoradiation therapy (n = 94) were identified and included in the study. Patients underwent treatment at the COH main campus site (n = 50) or satellite sites (n = 44). The majority of patients were Caucasian, male, and diagnosed with p16 positive stage IV locally advanced OPSCC by AJCC 7th edition. Most patients completed their prescribed cumulative radiation therapy dose and had a complete response to treatment. No significant difference in overall survival and progression-free survival was observed between the main campus and the satellite sites. Our study demonstrates successful treatment completion rates as well as comparable recurrence rates between the main campus and COH-associated satellite sites. A trend toward significant difference in feeding tube dependency at 6-months was observed. Differences in feeding tube placement and dependency rates could be addressed by the establishment of on-site supportive services in satellite sites.
Collapse
|
22
|
The natural history of weight and swallowing outcomes in oropharyngeal cancer patients following radiation or concurrent chemoradiation therapy. Support Care Cancer 2020; 29:1597-1607. [PMID: 32740893 DOI: 10.1007/s00520-020-05628-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/10/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE Patients treated for oropharyngeal cancer (OPC) are at increased risk for functional decline due to cancer-related impairments and treatment toxicities, often leading to recommendations for enteral nutritional support. This study investigated the natural history of weight and swallowing outcomes in patients with and without feeding tube (FT) placement. METHODS Data were collected from electronic medical records of OPC patients treated with (chemo)radiotherapy at a single regional cancer center between January 2013 and December 2015. Weight measurements, Functional Oral Intake Scale (FOIS) scores, Performance Status Scale for Head and Neck Cancer (PSS-HN) normalcy of diet scores, and M.D. Anderson Dysphagia Inventory (MDADI) composite scores were gathered at baseline and at 3-, 6-, and 12-months post-treatment. Patients were grouped based on FT placement and change over time was assessed using linear mixed effects analysis. RESULTS Of 122 eligible patients, 38 (31.1%) received a FT (FT group). Compared with baseline, weight decreased significantly at 3 and 6 months in both groups and at 12 months for patients without a FT (NFT group). Swallowing-related quality of life (QoL) decreased significantly at 3 and 6 months only in the NFT group. CONCLUSION OPC patients experience clinically relevant decreases in weight and swallowing-related QoL in the first-year post-treatment irrespective of FT placement. These findings will contribute to improved patient monitoring and communication within the clinical setting which may ultimately lead to better outcomes for those with OPC.
Collapse
|
23
|
Aylward A, Park J, Abdelaziz S, Hunt JP, Buchmann LO, Cannon RB, Rowe K, Snyder J, Deshmukh V, Newman M, Wan Y, Fraser A, Smith K, Lloyd S, Hitchcock Y, Hashibe M, Monroe MM. Individualized prediction of late-onset dysphagia in head and neck cancer survivors. Head Neck 2020; 42:708-718. [PMID: 32031294 DOI: 10.1002/hed.26039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 10/28/2019] [Accepted: 12/03/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Limited data exist regarding which head and head and neck cancer (HNC) survivors will suffer from long-term dysphagia. METHODS From a population-based cohort of 1901 Utah residents with HNC and ≥3 years follow-up, we determined hazard ratio for dysphagia, aspiration pneumonia, or gastrostomy associated with various risk factors. We tested prediction models with combinations of factors and then assessed discrimination of our final model. RESULTS Cancer site in the hypopharynx, advanced tumor classification, chemoradiation, preexisting dysphagia, stroke, dementia, esophagitis, esophageal spasm, esophageal stricture, gastroesophageal reflux, thrush, or chronic obstructive pulmonary disease were associated with increased risk of long-term dysphagia. Our final prediction tool gives personalized risk calculation for diagnosis of dysphagia, aspiration pneumonia, or gastrostomy tube placement at 5, 10, and 15 years after HNC based on 18 factors. CONCLUSION We developed a clinically useful risk prediction tool to identify HNC survivors most at risk for dysphagia.
Collapse
Affiliation(s)
- Alana Aylward
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Jihye Park
- Cancer Control and Population Science, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Sarah Abdelaziz
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Jason P Hunt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Luke O Buchmann
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Richard B Cannon
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Kerry Rowe
- Intermountain Healthcare, Salt Lake City, Utah
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, Utah
| | | | - Michael Newman
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Yuan Wan
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Alison Fraser
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Ken Smith
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Shane Lloyd
- Department of Radiation Oncology, Radiation Oncology, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Ying Hitchcock
- Department of Radiation Oncology, Radiation Oncology, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Mia Hashibe
- Department of Family and Preventive Medicine, Division of Public Health, University of Utah School of Medicine, Salt Lake City, Utah
| | - Marcus M Monroe
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah
| |
Collapse
|
24
|
Lang K, ElShafie RA, Akbaba S, Koschny R, Bougatf N, Bernhardt D, Welte SE, Adeberg S, Häfner M, Kargus S, Plinkert PK, Debus J, Rieken S. Percutaneous Endoscopic Gastrostomy Tube Placement in Patients with Head and Neck Cancer Treated with Radiotherapy. Cancer Manag Res 2020; 12:127-136. [PMID: 32021429 PMCID: PMC6955619 DOI: 10.2147/cmar.s218432] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/02/2019] [Indexed: 12/12/2022] Open
Abstract
Background and aim The primary aim of our study was to evaluate percutaneous endoscopic gastrostomy (PEG) tube placement depending on body weight and body mass index in patients undergoing radiotherapy (RT) for head and neck cancer (HNC). A secondary aim was to evaluate the course of weight change following PEG placement. Methods We retrospectively reviewed the medical records of 186 patients with HNC undergoing radiotherapy (RT) or chemoradiotherapy (CRT) at our institution between January 2010 and August 2017. Initial weight and nutritional intake were analyzed prior to RT initiation and then followed throughout treatment until completion. Based on these data, the indication of PEG placement was determined. Medical records were also reviewed to analyze PEG-related acute toxicities. Results A total of 186 patients met inclusion criteria. Patients were most commonly male (n=123, 66.1%) with squamous cell carcinoma (n=164, 88.2%). Patients who had dysphagia prior to treatment initiation as well as patients with a BMI <18.5 kg/m2 needed PEG placement earlier during the treatment course. Low-grade toxicities related to PEG insertion were observed in 10.7% patients, with peristomal pain and redness adjacent to the PEG tube insertion site being most common. High-grade toxicities, such as peritonitis and organ injury, were found in 4.9% of patients. Conclusion Underweight patients and those with preexisting dysphagia should be closely screened during RT for weight loss and decreased oral intake. For weight loss greater than 4.5% during the treatment of HNC, early PEG-tube placement should be considered. Further prospective studies are needed to confirm these findings, and delineate a scoring system for timing of PEG use (prophylactic vs reactive) as well as assess the quality of life in patients with HNC who receive PEG placement.
Collapse
Affiliation(s)
- Kristin Lang
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany
| | - Rami A ElShafie
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany
| | - Sati Akbaba
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany
| | - Ronald Koschny
- Department of Internal Medicine, University of Heidelberg, Heidelberg, Germany
| | - Nina Bougatf
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Stefan E Welte
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Matthias Häfner
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Steffen Kargus
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg 69120, Germany
| | - Peter K Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| |
Collapse
|
25
|
Hermann GM, Iovoli AJ, Platek AJ, Wang C, Miller A, Attwood K, Bourgeois DJ, Singh AK. A single-institution, randomized, pilot study evaluating the efficacy of gabapentin and methadone for patients undergoing chemoradiation for head and neck squamous cell cancer. Cancer 2019; 126:1480-1491. [PMID: 31869451 DOI: 10.1002/cncr.32676] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/14/2019] [Accepted: 11/17/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND The objective of the current study was to compare the safety and efficacy between 2 analgesic regimens for patients with head and neck cancer (HNC) undergoing definitive chemoradiation (CRT). METHODS The current study was a prospective, single-institution, 2-arm, randomized pilot study. Patients with American Joint Committee on Cancer seventh edition stage II to stage IV squamous cell carcinoma of the head and neck who were undergoing CRT were randomized to either arm 1, which entailed high-dose gabapentin (2700 mg daily) with the institutional standard of care (hydrocodone and/or acetaminophen progressing to fentanyl as needed), or arm 2, which comprised low-dose gabapentin (900 mg daily) with methadone. The primary endpoints were safety and toxicity. Secondary endpoints were pain, opioid requirement, and quality of life (QOL). Differences between the treatment arms at multiple time points were compared using a generalized linear mixed regression model with Sidak correction. RESULTS A total of 60 patients (31 in arm 1 and 29 in arm 2) were enrolled from April 2015 to August 2017. There was no difference between the treatment arms with regard to adverse events or serious adverse events. Pain was not found to be different between the treatment arms. More patients in arm 1 did not require an opioid during treatment (42% vs 7%; P = .002). Patients in arm 2 experienced significantly better QOL outcomes across multiple domains, including overall health (P = .05), physical functioning (P = .04), role functioning (P = .01), and social functioning (P = .01). CONCLUSIONS High-dose prophylactic gabapentin increased the percentage of patients who required no opioid during treatment. Methadone may improve QOL compared with a regimen of short-acting opioids and fentanyl. However, pain was found to significantly worsen throughout treatment regardless of treatment arm, necessitating further studies to identify a more optimal regimen.
Collapse
Affiliation(s)
- Gregory M Hermann
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Austin J Iovoli
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Alexis J Platek
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Chong Wang
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Austin Miller
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Daniel J Bourgeois
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York.,Radiation Oncology, Mary Bird Perkins Cancer Center, Baton Rouge, Louisiana
| | - Anurag K Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| |
Collapse
|
26
|
Hausmann J, Kubesch A, Müller von der Grün J, Goettlich CM, Filmann N, Oliver Tal A, Vermehren J, Friedrich-Rust M, Wächtershäuser A, Bojunga J, Blumenstein I. Prophylactic percutaneous endoscopic gastrostomy in patients with head and neck cancer: Influence on nutritional status, utilisation rate and complications. Int J Clin Pract 2019; 73:e13405. [PMID: 31408231 DOI: 10.1111/ijcp.13405] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/30/2019] [Accepted: 08/08/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients with head and neck cancer (HNC) are at high risk for malnutrition because of tumour localisation and therapy. Prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement is common practice to prevent malnutrition. OBJECTIVE To investigate the benefits of prophylactic PEG tube placement for HNC patients in terms of the influence on patients' nutritional status, utilisation rate, complications and to identify the predictors of PEG tube utilisation. METHODS All consecutive HNC patients who underwent prophylactic PEG tube insertion between 1 January 2011 and 31 December 2012 prior to therapy were enrolled. The PEG tube utilisation rate, complications, the patients' nutritional status and tumour therapy were evaluated with the help of electronic patient charts and telephone interviews. RESULTS A total of 181 patients (48 female, median 67.5 years) were included. The PEG utilisation rate in the entire cohort was 91.7%. One hundred and forty-nine patients (82.3%) used the PEG tube for total enteral nutrition, 17 patients (9.4%) for supplemental nutrition and 15 patients (8.3%) made no use of the PEG tube. Peristomal wound infections were the most common complications (40.3%) in this study. A high Nutritional Risk Screening (NRS) score prior to tube insertion was found to be independently associated with PEG utilisation. No significant weight changes were observed across the three patient subgroups. CONCLUSIONS The overall PEG tube utilisation rate was high in this study. However, given the high rate of infections, diligent patient selection is crucial in order to determine which patients benefit most from prophylactic PEG tube insertion.
Collapse
Affiliation(s)
- Johannes Hausmann
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Alica Kubesch
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jens Müller von der Grün
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Carmen M Goettlich
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Natalie Filmann
- Institute of Biostatistics and Mathematical Modeling, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andrea Oliver Tal
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Johannes Vermehren
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Astrid Wächtershäuser
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jörg Bojunga
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Irina Blumenstein
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| |
Collapse
|
27
|
Quality of life of patients with head and neck cancer after prophylactic percutaneous-gastrostomy. Eur J Clin Nutr 2019; 74:565-572. [PMID: 31570758 DOI: 10.1038/s41430-019-0499-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND HNC patients often experience weight loss during treatment. To date, there is only limited data on patient quality of life (QLQ) and subjective benefit of the PEG insertion. OBJECTIVE To investigate the nutritional status, QLQ, and overall benefit. METHODS 181 patients fitting our inclusion criteria (01/2012-12/2012) were enrolled. Utilization rate, nutritional status, QLQ, and subjective PEG assessment were determined with electronic charts and the Quality of life-questionnaire (EORTC-QLQ-C30). RESULTS The utilization rate of the entire cohort was 91.7%. The PEG was used full-time by 149 patients. No statistical differences in QLQ were observed between the groups. Of the patients that used the PEG entirely (99.7%), partially (85.3%) or not all (55.3%) would 99.7%, 85.3 and 55.8% undergo the procedure in the future if necessary. CONCLUSIONS QLQ was not significantly reduced by insertion. Especially patients using the PEG full-time had an objective and subjective benefit from the inserted PEG tube.
Collapse
|
28
|
Aylward A, Abdelaziz S, Hunt JP, Buchmann LO, Cannon RB, Rowe K, Snyder J, Wan Y, Deshmukh V, Newman M, Fraser A, Smith K, Herget K, Lloyd S, Hitchcock Y, Hashibe M, Monroe MM. Rates of Dysphagia-Related Diagnoses in Long-Term Survivors of Head and Neck Cancers. Otolaryngol Head Neck Surg 2019; 161:643-651. [PMID: 31184260 PMCID: PMC6773495 DOI: 10.1177/0194599819850154] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 04/23/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To estimate long-term prevalence of new dysphagia-related diagnoses in a large cohort of head and neck cancer survivors. STUDY DESIGN Retrospective cohort. SETTING Population based. SUBJECTS AND METHODS In total, 1901 adults diagnosed with head and neck cancer between 1997 and 2012 with at least 3 years of follow-up were compared with 7796 controls matched for age, sex, and birth state. Prevalence of new dysphagia-related diagnoses and procedures and hazard ratio compared to controls were evaluated in patients 2 to 5 years and 5 years and beyond after diagnosis. Risk factors for the development of these diagnoses were analyzed. RESULTS Prevalence of new diagnosis and hazard ratio compared to controls remained elevated for all diagnoses throughout the time periods investigated. The rate of aspiration pneumonia was 3.13% at 2 to 5 years, increasing to 6.75% at 5 or more years, with hazard ratios of 9.53 (95% confidence interval [CI], 5.08-17.87) and 12.57 (7.17-22.04), respectively. Rate of gastrostomy tube placement increased from 2.82% to 3.32% with hazard ratio remaining elevated from 51.51 (13.45-197.33) to 35.2 (7.81-158.72) over the same time period. The rate of any dysphagia-related diagnosis or procedure increased from 14.9% to 26% with hazard ratio remaining elevated from 3.32 (2.50-4.42) to 2.12 (1.63-2.75). Treatment with radiation therapy and age older than 65 years were associated with increased hazard ratio for dysphagia-related diagnoses. CONCLUSION Our data suggest that new dysphagia-related diagnoses continue to occur at clinically meaningful levels in long-term head and neck cancer survivors beyond 5 years after diagnosis.
Collapse
Affiliation(s)
- Alana Aylward
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT
| | - Sarah Abdelaziz
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT
| | - Jason P. Hunt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT
| | - Luke O. Buchmann
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT
| | - Richard B. Cannon
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT
| | - Kerry Rowe
- Intermountain Healthcare, Salt Lake City, UT
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, UT
| | - Yuan Wan
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Michael Newman
- University of Utah Health Sciences Center, Salt Lake City, UT
| | - Alison Fraser
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
| | - Ken Smith
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
| | - Kim Herget
- Utah Cancer Registry, University of Utah, Salt Lake City, UT
| | - Shane Lloyd
- Department of Radiation Oncology, Radiation Oncology, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT
| | - Ying Hitchcock
- Department of Radiation Oncology, Radiation Oncology, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT
| | - Mia Hashibe
- Department of Family and Preventive Medicine, Division of Public Health, University of Utah School of Medicine, Salt Lake City, UT
| | - Marcus M. Monroe
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT
| |
Collapse
|
29
|
Chhabria K, Kansara S, Badr H, Stach C, Vernese M, Lerner A, Harms A, Hernandez DJ, Huang AT, Chen G, Parke RB, Charnitsky S, Sandulache VC. Gastrostomy Utilization by Oropharyngeal Cancer Patients Is Partially Driven by Swallowing Function. Laryngoscope 2019; 130:2153-2159. [PMID: 31566749 DOI: 10.1002/lary.28312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/26/2019] [Accepted: 09/03/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Oropharyngeal squamous cell carcinoma (OPSCC) incidence is rapidly increasing, as are survival rates, in large part due to the human papillomavirus (HPV). Treatment intensity, however, has remained unchanged, making treatment-related toxicity (i.e., dysphagia) a critical problem for an increasing number of patients. The primary objective of this study was to determine whether pretreatment objective swallowing measures can predict percutaneous fluoroscopic guided gastrostomy tube (PFG) utilization during OPSCC treatment. METHODS Forty-one newly diagnosed OPSCC patients treated with radiation underwent evaluation of swallow function with modified barium swallow study (MBSS) prior to and at completion of radiation treatment using the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST); a subset of patients were evaluated using the MD Anderson Dysphagia Inventory (MDADI). RESULTS Patients were male (100%), primarily Caucasian (85.4%) and p16 positive (85.4%) with mean age of 65.7 years. PFG were placed in 70.7% patients (n = 29) and used by 63.4% (n = 26). Pre- and post-treatment DIGEST scores were associated with T-classification (t = -2.9, p = .001, t = -2.7, p = .01) and indicated deteriorating swallow function during treatment (mean change = 0.46 [t = -2.7, p = .01]). DIGEST and MDADI scores were generally not associated with patient PFG utilization. DIGEST and MDADI scores were significantly correlated prior to, but not following completion of treatment. CONCLUSION Pre-treatment DIGEST and patient reported swallowing outcomes (MDADI) can be useful in identifying patients with unsafe and/or grossly inefficient swallowing function. However, objectively measured swallow function was not associated with PFG utilization. Development of PFG placement algorithms (reactive vs. prophylactic) therefore require additional inputs/metrics. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2153-2159, 2020.
Collapse
Affiliation(s)
- Karishma Chhabria
- Department of Medicine, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Sagar Kansara
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Hoda Badr
- Department of Medicine, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Carol Stach
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,Speech Pathology Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - Madeline Vernese
- Speech Pathology Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - Allison Lerner
- Speech Pathology Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - Aaron Harms
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - David J Hernandez
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - Andrew T Huang
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - George Chen
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Robert B Parke
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - Scott Charnitsky
- ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - Vlad C Sandulache
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| |
Collapse
|
30
|
External validation of a multifactorial normal tissue complication probability model for tube feeding dependence at 6 months after definitive radiotherapy for head and neck cancer. Radiother Oncol 2018; 129:403-408. [DOI: 10.1016/j.radonc.2018.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/12/2018] [Accepted: 09/18/2018] [Indexed: 11/20/2022]
|
31
|
McClelland S, Andrews JZ, Chaudhry H, Teckie S, Goenka A. Prophylactic versus reactive gastrostomy tube placement in advanced head and neck cancer treated with definitive chemoradiotherapy: A systematic review. Oral Oncol 2018; 87:77-81. [PMID: 30527247 DOI: 10.1016/j.oraloncology.2018.10.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/19/2018] [Accepted: 10/21/2018] [Indexed: 01/25/2023]
Abstract
Although chemoradiotherapy (CRT) has improved disease outcomes in advanced head and neck cancer (aHNC), toxicity remains a major concern. Treatment interruptions and decreased quality of life (QOL) can occur due to malnutrition, secondary to mucositis, dysphagia and odynophagia. Gastrostomy tubes are used in many patients to improve nutrition during CRT. The optimal timing of PEG placement in patients with aHNC undergoing CRT remains controversial. Using the PubMed database, we performed a systematic review of published CRT series in aHNC to guide decision-making regarding optimal timing of percutaneous endoscopic gastrostomy (PEG) placement. We aimed to compare outcomes when patients are treated with prophylactic PEG (pPEG) versus reactive PEG (rPEG). Twenty-two studies examining the role of PEG placement in CRT for aHNC were reviewed. pPEG reduces the number of malnourished patients (defined as >10% of body weight), but average weight loss at various time points following treatment appears similar to patients with rPEG. pPEG is also associated with improved QOL at 6 months, and greater long term PEG dependence. Clinical and dosimetric parameters that correlate with malnutrition in patients without pPEG include advanced age, percent weight loss preceding treatment, and radiation dose to the pharyngeal constrictor muscles. Based on this evidence, our institutional strategy is to encourage pPEG in those patients deemed at greatest risk of becoming malnourished during the course of treatment, and to approach the remainder of patients with rPEG.
Collapse
Affiliation(s)
- Shearwood McClelland
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, United States; Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Janna Z Andrews
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Huma Chaudhry
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Sewit Teckie
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Anuj Goenka
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.
| |
Collapse
|
32
|
Takahashi M, Kosaka N, Wakui E, Iwaki S, Nishii M, Teshima M, Shinomiya H, Morimoto K, Kiyota N, Sasaki R, Usami M, Otsuki N, Nibu KI. Role of intensive nutrition support and prophylactic percutaneous endoscopic gastrostomy during concomitant chemoradiotherapy for oropharyngeal cancer. Int J Clin Oncol 2018; 23:1023-1028. [PMID: 30121869 DOI: 10.1007/s10147-018-1328-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/31/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Concomitant chemoradiotherapy (CCRT) produces severe mucositis and swallowing dysfunction, often resulting in malnutrition. Intensive nutrition support (INS) in addition to percutaneous endoscopic gastrostomy (PEG) is reported to decrease adverse effects during CCRT. PATIENTS AND METHODS Fifty-eight patients with oropharyngeal cancer treated by CDDP-based CCRT were retrospectively analyzed. Twenty-nine patients treated with INS in addition to PEG were classified as INS group, and other 29 patients treated with PEG but without INS were classified as control group. RESULTS INS in addition to PEG significantly increased calorie intake in the second half of CCRT and reduced adverse events including mucositis (p = 0.0019), leukopenia (p = 0.04), and renal function (p = 0.006). Moreover, 21 out of 29 patients had successfully administration of 200 mg/m2 or more of CDDP, while only 10 out of 29 patients had enough amount of CDDP in control group. CONCLUSIONS These results suggest that INS in addition to prophylactic PEG not only decreases adverse effects but also may potentially improve oncological outcome of the patients with oropharyngeal cancer treated by CCRT.
Collapse
Affiliation(s)
- Miki Takahashi
- Department of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Nana Kosaka
- Division of Nutrition and Metabolism, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Emi Wakui
- Department of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Shinobu Iwaki
- Department of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Mika Nishii
- Department of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Masanori Teshima
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan
| | - Koichi Morimoto
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan
| | - Ryohei Sasaki
- Department of Radiation Oncology, Kobe University Hospital, Kobe, Japan
| | - Makoto Usami
- Division of Nutrition and Metabolism, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Naoki Otsuki
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan.
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan
| |
Collapse
|
33
|
Xinou E, Chryssogonidis I, Kalogera-Fountzila A, Panagiotopoulou-Mpoukla D, Printza A. Longitudinal Evaluation of Swallowing with Videofluoroscopy in Patients with Locally Advanced Head and Neck Cancer After Chemoradiation. Dysphagia 2018; 33:691-706. [DOI: 10.1007/s00455-018-9889-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 03/17/2018] [Indexed: 10/17/2022]
|
34
|
Vangelov B, Kotevski DP, Williams JR, Smee RI. The impact of HPV status on weight loss and feeding tube use in oropharyngeal carcinoma. Oral Oncol 2018; 79:33-39. [PMID: 29598948 DOI: 10.1016/j.oraloncology.2018.02.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/05/2018] [Accepted: 02/11/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES It has been well established that patients with oropharyngeal carcinoma are at high nutritional risk, with significant weight loss and tube feeding common. Human papillomavirus (HPV)-associated disease has led to a change in the "typical" presentation and nutritional profile of this population. The aim of our study was to determine whether the need for a feeding tube, and weight loss during radiotherapy (RT) in patients with oropharyngeal carcinoma differed with HPV status. MATERIALS AND METHODS Patients who received curative RT ± chemotherapy from January 2011 to January 2016 were included (n = 100). We retrospectively evaluated feeding tube use and timing of insertion (prophylactic vs reactive), percentage weight loss during RT and the prevalence of critical weight loss (CWL) ≥5%. RESULTS HPV-positive patients had significantly higher weight loss during RT compared to the rest of the cohort (8.4% vs 6.1%, 95%CI 0.8-3.9, p = 0.003). CWL was observed in 86% and in a higher proportion with HPV-positive disease (93%, p = 0.011). Conditional probability modelling analysis revealed, with 74% accuracy, concurrent chemoradiotherapy and HPV-positive status were predictors of CWL when comparing HPV-positive patients to HPV-negative (96%, p = 0.001 and 98%, p = 0.012 respectively). More HPV-positive patients required feeding tubes (n = 43, 63%, p = 0.05), most being reactive (n = 27, 63%). All patients with reactive tubes experienced CWL. CONCLUSION The high incidence of CWL in patients with HPV-positive oropharyngeal carcinoma is of concern. Tube feeding continues to be a necessary nutritional intervention in this population and predicting who will require a tube is challenging. Larger, prospective cohort studies are required.
Collapse
Affiliation(s)
- Belinda Vangelov
- Department of Radiation Oncology, The Nelune Comprehensive Cancer Centre, The Prince of Wales Hospital, Randwick, New South Wales, Australia.
| | - Damian P Kotevski
- Department of Radiation Oncology, The Nelune Comprehensive Cancer Centre, The Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Janet R Williams
- Department of Radiation Oncology, The Nelune Comprehensive Cancer Centre, The Prince of Wales Hospital, Randwick, New South Wales, Australia; University of New South Wales Clinical Teaching School, The Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Robert I Smee
- Department of Radiation Oncology, The Nelune Comprehensive Cancer Centre, The Prince of Wales Hospital, Randwick, New South Wales, Australia; University of New South Wales Clinical Teaching School, The Prince of Wales Hospital, Randwick, New South Wales, Australia; Department of Radiation Oncology, Tamworth Base Hospital, Tamworth, NSW, Australia
| |
Collapse
|
35
|
Metkus JS, Cognetti D, Curry J. Percutaneous gastrostomy site metastasis from head and neck tumors: A single institution case series. Laryngoscope Investig Otolaryngol 2017; 2:395-397. [PMID: 29299514 PMCID: PMC5743160 DOI: 10.1002/lio2.127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/21/2017] [Indexed: 11/09/2022] Open
Abstract
Objectives Head and neck cancer (HNC) patients often require percutaneous gastrostomy (PEG) tube placement due to malnutrition and dysphagia. While beneficial, PEG tube placement can cause a rare but reportable complication of metastasis of the original tumor to the gastrostomy exit site. The objectives of this case series were to present HNC patients at a single institution that developed PEG tube metastases, their subsequent treatment, and review of the literature for similar cases. Methods We describe three HNC patients who underwent PEG tube placement and developed metastasis at their tube site. We also describe their metastatic disease treatment and compare these cases with similar cases in the literature. Results All three cases' initial staging were node positive and all three cases had their PEG tubes placed by the "pull" method. Two patients presented with masses at their PEG site while one patient had a site mass on surveillance positron emission topography (PET) imaging. Biopsy showed the original HNC metastasized to the gastrostomy site. Two patients were treated with surgical resection while one patient was treated with palliative chemotherapy. The "pull" method has been most associated with cases of metastasis in the literature. In the literature, risk factors for metastasis include initial tumor clinical and pathological staging. Conclusion PEG site metastasis should be suspected in patients with skin changes at the PEG site. "Pull" procedures may cause metastasis through physical contact with the primary tumor causing tumor seeding at the PEG site. Surgical resection of metastasis has been shown to be an effective treatment strategy for PEG site metastasis. In patients with higher stage cancers, tube insertion methods that avoid contact with the primary tumor should be considered. Level of Evidence NA.
Collapse
Affiliation(s)
- James S Metkus
- Department of Otolaryngology Thomas Jefferson University Philadelphia Pennsylvania
| | - David Cognetti
- Department of Otolaryngology Thomas Jefferson University Philadelphia Pennsylvania
| | - Joseph Curry
- Department of Otolaryngology Thomas Jefferson University Philadelphia Pennsylvania
| |
Collapse
|
36
|
Ruohoalho J, Aro K, Mäkitie AA, Atula T, Haapaniemi A, Keski-Säntti H, Kylänpää L, Takala A, Bäck LJ. Prospective experience of percutaneous endoscopic gastrostomy tubes placed by otorhinolaryngologist-head and neck surgeons: safe and efficacious. Eur Arch Otorhinolaryngol 2017; 274:3971-3976. [PMID: 28865046 DOI: 10.1007/s00405-017-4732-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
Abstract
Percutaneous endoscopic gastrostomy (PEG) is often the treatment of choice in head and neck cancer (HNC) patients needing long-term nutritional support. Prospective studies on PEG tube placement in an otorhinolaryngologist service are lacking. At our hospital, otolaryngologist-head and neck (ORL-HN) surgeons-have performed PEG insertions for HNC patients since 2008. We prospectively analyzed 127 consecutive HNC patients who received their PEG tubes at the Department of Otorhinolaryngology-head and neck surgery, and evaluated the outcome of PEG tube insertions performed by ORL-HN surgeons. To compare time delays before and after, PEG placement service was transferred from gastrointestinal surgeons to ORL-HN surgeons, and we retrospectively analyzed a separate group of 110 HNC patients who had earlier received PEG tubes at the Department of Gastrointestinal Surgery. ORL-HN surgeons' success rate in PEG insertion was 97.6%, leading to a final prospective study group of 124 patients. Major complications occurred in four (3.2%): two buried bumper syndromes, one subcutaneous hemorrhage leading to an abscess in the abdominal wall, and one metastasis at the PEG site. The most common minor complication was peristomal granulomatous tissue affecting 23 (18.5%) patients. After the change in practice, median time delay before PEG insertion decreased from 13 to 10 days (P < 0.005). The proportion of early PEG placements within 0-3 days increased from 3.6 to 14.6% (P < 0.005). PEG tube insertion seems to be a safe procedure in the hands of an ORL-HN surgeon. Independence from gastrointestinal surgeons' services reduced the time delay and improved the availability of urgent PEG insertions.
Collapse
Affiliation(s)
- Johanna Ruohoalho
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029, Helsinki, Finland.
| | - Katri Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029, Helsinki, Finland
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029, Helsinki, Finland
| | - Aaro Haapaniemi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029, Helsinki, Finland
| | - Harri Keski-Säntti
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029, Helsinki, Finland
| | - Leena Kylänpää
- Department of Gastrointestinal and General Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029, Helsinki, Finland
| | - Annika Takala
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029, Helsinki, Finland
| | - Leif J Bäck
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029, Helsinki, Finland
| |
Collapse
|
37
|
Maggiore R, Zumsteg ZS, BrintzenhofeSzoc K, Trevino KM, Gajra A, Korc-Grodzicki B, Epstein JB, Bond SM, Parker I, Kish JA, Murphy BA, VanderWalde NA. The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment. Int J Radiat Oncol Biol Phys 2017; 98:868-883. [PMID: 28602414 DOI: 10.1016/j.ijrobp.2017.02.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/23/2017] [Accepted: 02/13/2017] [Indexed: 02/06/2023]
Abstract
Older adults with head and neck squamous cell carcinoma (HNSCC) pose unique treatment and supportive care challenges to oncologists and other cancer care providers. The majority of patients with HNSCC present with locoregionally advanced disease, for which combined-modality treatment integrating chemotherapy and radiation therapy is often necessary to maximize tumor control. However, applying these approaches to an older population with concomitant comorbidities and a higher risk of functional impairments remains challenging and is exacerbated by the paucity of studies involving older adults. The purpose of this article is to identify knowledge gaps in the evaluation and management of older adults with HNSCC-particularly those undergoing concurrent chemoradiation therapy-and their caregivers through a review of the literature conducted by clinicians, researchers, and patient advocates. The findings highlight the importance of a geriatric assessment and the therapeutic paradigms and challenges relevant to this population. Furthermore, we identify the need for additional research and interventions related to key supportive care issues that arise during and after treatment in older adults with locoregionally advanced HNSCC. On the basis of our findings, we prioritize these issues to guide future patient-oriented research endeavors to address these knowledge gaps and thus better serve this growing patient population.
Collapse
Affiliation(s)
- Ronald Maggiore
- Division of Hematology/Oncology, Department of Medicine, University of Rochester, Rochester, New York
| | - Zachary S Zumsteg
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Kelly M Trevino
- Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Ajeet Gajra
- Division of Hematology/Oncology, Department of Medicine, SUNY Upstate Medical University Cancer Center, Syracuse, New York
| | | | - Joel B Epstein
- Department of Oral Medicine and Diagnostic Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stewart M Bond
- Boston College William F. Connell School of Nursing, Chestnut Hill, Massachusetts
| | - Ira Parker
- University of California, San Diego School of Medicine, La Jolla, California
| | - Julie A Kish
- Division of Hematology/Oncology, Department of Medicine, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Barbara A Murphy
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Noam A VanderWalde
- Department of Radiation Oncology, University of Tennessee Health Science Center-West Cancer Center, Memphis, Tennessee.
| | | |
Collapse
|
38
|
Vangelov B, Smee RI. Clinical predictors for reactive tube feeding in patients with advanced oropharynx cancer receiving radiotherapy ± chemotherapy. Eur Arch Otorhinolaryngol 2017; 274:3741-3749. [PMID: 28748260 DOI: 10.1007/s00405-017-4681-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/19/2017] [Indexed: 11/30/2022]
Abstract
Enteral feeding is often required for nutrition support in head and neck cancer patients when oral intake is inadequate. When to initiate the insertion of a feeding tube continues to be a debated issue in our institution. We investigated the use of reactive feeding tubes (RFTs) in patients with advanced stage oropharynx cancer (OPC). Data were retrospectively collected on 131 patients who had radiotherapy (RT) ± chemotherapy from 2005 to 2015. Predictors for RFT insertion were investigated. Weight loss during RT was compared between those with RFT versus prophylactic tubes (PFTs) versus no tube, and survival outcomes evaluated. RFTs were more likely to be needed in patients who had bilateral neck node irradiation (p = 0.001) and concurrent chemoradiotherapy (CRT) (p = 0.038). Patients with RFTs had significantly higher mean percentage weight loss during RT (9.5 ± 3.4%) (p < 0.001) when compared to those with a PFT (5.2 ± 4.7%) and those with no tube (5.4 ± 3.1%). No difference was seen in 5-year survival rates in patients who did not have a feeding tube to those who required a RFT. RFT use is frequent in OPC, although difficult to predict. CRT and bilateral neck node irradiation were found to be associated with the need for the insertion of a feeding tube during RT. These patients also experience significantly higher weight loss, therefore, prophylactic tubes may need to be considered more often in this population.
Collapse
Affiliation(s)
- Belinda Vangelov
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, The Prince of Wales Hospital and Community Health Services, Randwick, NSW, Australia. .,Department of Nutrition and Dietetics, The Prince of Wales Hospital, Randwick, NSW, Australia.
| | - Robert I Smee
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, The Prince of Wales Hospital and Community Health Services, Randwick, NSW, Australia.,University of New South Wales Clinical Teaching School, Prince of Wales Hospital, Randwick, NSW, Australia.,Department of Radiation Oncology, Tamworth Base Hospital, Tamworth, NSW, Australia
| |
Collapse
|
39
|
Nesemeier R, Dunlap N, McClave SA, Tennant P. Evidence-Based Support for Nutrition Therapy in Head and Neck Cancer. CURRENT SURGERY REPORTS 2017; 5:18. [PMID: 32288971 PMCID: PMC7102400 DOI: 10.1007/s40137-017-0179-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Patients diagnosed with head and neck (H&N) cancer often present in a malnourished state for varied reasons; nutritional optimization is therefore critical to the success of treatment for these complex patients. This article aims to review the current nutrition literature pertaining to H&N cancer patients and to present evidence-based strategies for nutritional support specific to this population. RECENT FINDINGS Aggressive nutritional intervention is frequently required in the H&N cancer patient population. Rehabilitating nutrition during operative and nonoperative treatment improves compliance with treatment, quality of life, and clinical outcomes. When and whether to establishing alternative enteral access are points of controversy, although recent evidence suggests prophylactic enteral feeding tube placement should not be universally applied. Perioperative nutritional optimization including preoperative carbohydrate loading and provision of arginine-supplemented immunonutrition has been shown to benefit at-risk H&N cancer patients. SUMMARY With multidisciplinary collaboration, H&N cancer patients can receive individualized nutritional support to withstand difficult cancer treatment regimens and return to acceptable states of nutritional health.
Collapse
Affiliation(s)
- Ryan Nesemeier
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, 529 S Jackson St., 3rd Floor, Louisville, KY 40202 USA
| | - Neal Dunlap
- Department of Radiation Oncology, University of Louisville, Louisville, KY USA
| | - Stephen A. McClave
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, University of Louisville, Louisville, KY USA
| | - Paul Tennant
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, 529 S Jackson St., 3rd Floor, Louisville, KY 40202 USA
| |
Collapse
|
40
|
Brown TE, Wittholz K, Way M, Banks MD, Hughes BGM, Lin CY, Kenny LM, Bauer JD. Investigation of p16 status, chemotherapy regimen, and other nutrition markers for predicting gastrostomy in patients with head and neck cancer. Head Neck 2017; 39:868-875. [DOI: 10.1002/hed.24630] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/05/2016] [Accepted: 10/07/2016] [Indexed: 12/23/2022] Open
Affiliation(s)
- Teresa E. Brown
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Queensland Australia
- Centre for Dietetic Research (C-DIET-R), School of Human Movement and Nutrition Sciences; University of Queensland; Brisbane Australia
| | - Kym Wittholz
- Centre for Dietetic Research (C-DIET-R), School of Human Movement and Nutrition Sciences; University of Queensland; Brisbane Australia
| | - Mandy Way
- QIMR; Berghofer Medical Research Institute; Herston Queensland Australia
| | - Merrilyn D. Banks
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Queensland Australia
| | - Brett G. M. Hughes
- Cancer Care Services; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Queensland Australia
| | - Charles Y. Lin
- Cancer Care Services; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Lizbeth M. Kenny
- Cancer Care Services; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Judith D. Bauer
- Centre for Dietetic Research (C-DIET-R), School of Human Movement and Nutrition Sciences; University of Queensland; Brisbane Australia
| |
Collapse
|
41
|
Brown TE, Banks MD, Hughes BGM, Lin CY, Kenny LM, Bauer JD. Comparison of Nutritional and Clinical Outcomes in Patients with Head and Neck Cancer Undergoing Chemoradiotherapy Utilizing Prophylactic versus Reactive Nutrition Support Approaches. J Acad Nutr Diet 2016; 118:627-636. [PMID: 27986517 DOI: 10.1016/j.jand.2016.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 10/13/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND The optimal method of tube feeding for patients with head and neck cancer remains unclear. A validated protocol is available that identifies high-nutritional-risk patients who would benefit from prophylactic gastrostomy tube placement. Adherence to this protocol is ultimately determined by clinical team discretion or patient decision. OBJECTIVE The study aim was to compare outcomes after adherence and nonadherence to this validated protocol, thus comparing a prophylactic and reactive approach to nutrition support in this patient population. DESIGN We conducted a prospective comparative cohort study. Patients were observed during routine clinical practice over 2 years. PARTICIPANTS/SETTING Patients with head and neck cancer having curative-intent treatment between August 2012 and July 2014 at a tertiary hospital in Queensland, Australia, were included if assessed as high nutrition risk according to the validated protocol (n=130). Patients were grouped according to protocol adherence as to whether they received prophylactic gastrostomy (PEG) per protocol recommendation (prophylactic PEG group, n=69) or not (no PEG group, n=61). MAIN OUTCOME MEASURES Primary outcome was percentage weight change during treatment. Secondary outcomes were feeding tube use and hospital admissions. STATISTICAL ANALYSIS PERFORMED Fisher's exact, χ2, and two sample t tests were performed to determine differences between the groups. Linear and logistic regression were used to examine weight loss and unplanned admissions, respectively. RESULTS Patients were 88% male, median age was 59 years, with predominantly stage IV oropharyngeal cancer receiving definitive chemoradiotherapy. Statistically significantly less weight loss in the prophylactic PEG group (7.0% vs 9.0%; P=0.048) and more unplanned admissions in the no PEG group (82% vs 75%; P=0.029). In the no PEG group, 26 patients (43%) required a feeding tube or had ≥10% weight loss. CONCLUSIONS Prophylactic gastrostomy improved nutrition outcomes and reduced unplanned hospital admissions. Additional investigation of characteristics of patients with minimal weight loss or feeding tube use could help refine and improve the protocol.
Collapse
|
42
|
van der Linden NC, Kok A, Leermakers-Vermeer MJ, de Roos NM, de Bree R, van Cruijsen H, Terhaard CHJ. Indicators for Enteral Nutrition Use and Prophylactic Percutaneous Endoscopic Gastrostomy Placement in Patients With Head and Neck Cancer Undergoing Chemoradiotherapy. Nutr Clin Pract 2016; 32:225-232. [DOI: 10.1177/0884533616682684] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Nina C. van der Linden
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
- Department of Internal Medicine and Dermatology, Dietetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annemieke Kok
- Department of Internal Medicine and Dermatology, Dietetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marja J. Leermakers-Vermeer
- Department of Internal Medicine and Dermatology, Dietetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicole M. de Roos
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hester van Cruijsen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chris H. J. Terhaard
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
43
|
Hardy S, Haas K, Vanston VJ, Angelo M. Prophylactic Feeding Tubes in Head and Neck Cancers #318. J Palliat Med 2016; 19:1343-1344. [PMID: 27898295 DOI: 10.1089/jpm.2016.0381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
44
|
Validation of an updated evidence-based protocol for proactive gastrostomy tube insertion in patients with head and neck cancer. Eur J Clin Nutr 2016; 70:574-81. [DOI: 10.1038/ejcn.2015.230] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 12/11/2015] [Accepted: 12/19/2015] [Indexed: 12/11/2022]
|
45
|
Gastrostomy in head and neck cancer: current literature, controversies and research. Curr Opin Otolaryngol Head Neck Surg 2015; 23:162-70. [PMID: 25692626 DOI: 10.1097/moo.0000000000000135] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW This article explores the literature on the role of gastrostomy tube feeding use in the management of head and neck cancer, with special attention to its indications, timing of insertion, advantages, complications and quality of life issues. RECENT FINDINGS The current guidelines in place across different countries and two ongoing randomized controlled trials are discussed in detail, and placed in the context of current evidence. SUMMARY There remains a lack of consensus about when and which enteral feeding routes (gastrostomy or nasogastric tube) should be used and controversy about the long-term effects on swallowing function as well as quality of life for patients. Local guidelines should be used or generated to guide practice or patients enrolled into existing trials until higher level evidence is generated.
Collapse
|
46
|
Bishop S, Reed WM. The provision of enteral nutritional support during definitive chemoradiotherapy in head and neck cancer patients. J Med Radiat Sci 2015; 62:267-76. [PMID: 27512573 PMCID: PMC4968562 DOI: 10.1002/jmrs.132] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 07/15/2015] [Accepted: 07/28/2015] [Indexed: 02/05/2023] Open
Abstract
Combination chemoradiation is the gold standard of management for locally advanced squamous cell carcinomas of the head and neck. One of the most significant advantages of this approach to treatment is organ preservation which may not be possible with radical surgery. Unfortunately, few treatments are without side-effects and the toxicity associated with combined modality treatment causes meaningful morbidity. Patients with head and neck cancer (HNC) may have difficulties meeting their nutritional requirements as a consequence of tumour location or size or because of the acute toxicity associated with treatment. In particular, severe mucositis, xerostomia, dysgeusia and nausea and vomiting limit intake. In addition to this, dysphagia is often present at diagnosis, with many patients experiencing silent aspiration. As such, many patients will require enteral nutrition in order to complete chemoradiotherapy (CRT). Feeding occurs via catheters placed transnasally (nasogastric tubes) or directly into the stomach through the anterior abdominal wall (percutaneous gastrostomy tubes). In the absence of clear evidence concerning the superiority of one method over another, the choice of feeding tube tends to be dependent on clinician and patient preference. This review examines key issues associated with the provision of enteral nutritional support during definitive CRT in HNC patients, including feeding methods, patient outcomes and timing of tube insertion and use.
Collapse
Affiliation(s)
- Sarah Bishop
- Illawarra Cancer Care CentreDepartment of Radiation Oncology, Wollongong HospitalWollongongNew South WalesAustralia
- Radiation Oncology DepartmentNelune Comprehensive Cancer CentrePrince of Wales HospitalRandwickNew South WalesAustralia
| | - Warren Michael Reed
- Medical Image Optimisation and Perception GroupDiscipline of Medical Radiation SciencesFaculty of Health SciencesThe University of SydneyLidcombeNew South WalesAustralia
| |
Collapse
|
47
|
Khanh NT, Iyer NG. Management of post-operative fistula in head and neck surgery: Sweeping it under the carpet? World J Otorhinolaryngol 2015; 5:93-104. [DOI: 10.5319/wjo.v5.i4.93] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 07/19/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
The most dreaded complication in head and neck surgery is the development of fistula. Fistulas are common and devastating. The prevalence and the risk factors that contribute to fistula formation after head and neck procedures were discussed briefly. The main goal of this manuscript is to discuss current management of head and neck fistula. We believed that the best management strategy for head and neck fistulas is prevention. We recommend a holistic preventive approach during the perioperative period. The roles of different types of wound products and hyperbaric oxygen therapy were also discussed and highlighted. We also discussed the operative repair of fistulas, which relies on the tenet of providing well-vascularized tissue to an area of poor wound healing. Most often, the surgeon’s preference and range of operative skills dictate the timing and the type of repair. We highlighted the use of the pectoralis major, a well-known flap, as well as a novel technique in the surgical repair of complex, difficult-to-heal head and neck fistula.
Collapse
|
48
|
Brown T, Banks M, Hughes BGM, Lin C, Kenny LM, Bauer JD. New radiotherapy techniques do not reduce the need for nutrition intervention in patients with head and neck cancer. Eur J Clin Nutr 2015; 69:1119-24. [PMID: 26306565 DOI: 10.1038/ejcn.2015.141] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/15/2015] [Accepted: 07/21/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Since 2007, our institution has used validated guidelines for the insertion of proactive gastrostomy feeding tubes in patients with head and neck cancer. Helical intensity-modulated radiotherapy (H-IMRT) delivered by Tomotherapy, is an advanced radiotherapy technique introduced at our centre in 2010. This form of therapy reduces long-term treatment-related toxicity to normal tissues. The aim of this study is to compare weight change and need for tube feeding following H-IMRT (n=53) with patients that would have previously been treated with three-dimensional conformal radiotherapy (n=134). SUBJECTS/METHODS Patients with head and neck cancer assessed as high nutritional risk with recommendation for proactive gastrostomy were identified from cohorts from 2007 to 2008 and 2010 to 2011. Retrospective data were collected on clinical factors, weight change from baseline to completion of treatment, incidence of severe weight loss (⩾ 10%) and tube feeding. Statistical analyses to compare outcomes between the two treatments included χ(2)-test, Fisher's exact and two-sample Wilcoxon tests (P<0.05). RESULTS The H-IMRT cohort had higher proportions of patients with definitive chemoradiotherapy (P=0.032) and more advanced N stage (P<0.001). Nutrition outcomes were not significantly different between H-IMRT and conformal radiotherapy, respectively: need for proactive gastrostomy (n=49, 92% versus n=115, 86%, P=0.213), median percentage weight change (-7.2% versus -7.3%, P=0.573) and severe weight loss incidence (28% versus 27%, P=0.843). CONCLUSIONS Both groups had median weight loss >5% and high incidences of tube feeding and severe weight loss. Nutrition intervention remains critical in this patient population, despite advances in radiotherapy techniques, and no changes to current management are recommended.
Collapse
Affiliation(s)
- T Brown
- Centre for Dietetics Research (C-DIET-R), School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - M Banks
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - B G M Hughes
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - C Lin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - L M Kenny
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - J D Bauer
- Centre for Dietetics Research (C-DIET-R), School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia
| |
Collapse
|
49
|
Vlooswijk CP, van Rooij PHE, Kruize JC, Schuring HA, Al-Mamgani A, de Roos NM. Dietary counselling and nutritional support in oropharyngeal cancer patients treated with radiotherapy: persistent weight loss during 1-year follow-ups. Eur J Clin Nutr 2015. [PMID: 26197875 DOI: 10.1038/ejcn.2015.102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES The need for dietary counselling and nutritional support in oropharyngeal cancer patients is generally accepted. However, evidence for the effectiveness is sparse. The aim of this study was to describe dietary counselling, nutritional support, body weight and toxicity during and after treatment, and investigate the effect of pre-treatment body mass index (BMI) on survival in oropharyngeal cancer patients. SUBJECTS/METHODS A retrospective chart review was made in 276 oropharyngeal cancer patients treated with radiotherapy (RT). End points were dietary consultations, weight loss, toxicity, overall survival and disease-free survival. RESULTS Almost all oropharyngeal cancer patients received dietary counselling (94%) and nutritional support (99%). Dietary counselling decreased sharply shortly after treatment to 38% at 1 year after treatment. Overall weight loss increased during the first year of follow-up and ranged from 3% at start of RT, until 11% at 1 year after RT. Overall survival was significantly longer for patients with a BMI above average (P=0.01). Acute dysphagia (P=0.001), mucositis (P=0.000) and toxicity grade 3 (P=0.002) were significantly more prevalent in patients who had lost 10% or more of their body weight. CONCLUSIONS This study showed that patients continue to lose body weight during and until 1 year after treatment, despite nutrition support and frequent dietetic consultation. A BMI above average appears to increase survival time. Future studies, preferably randomized trials, are needed to compare standard dietary counselling with more intensive dietary counselling that consists of earlier and/or prolonged treatment.
Collapse
Affiliation(s)
- C P Vlooswijk
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - P H E van Rooij
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - J C Kruize
- Department of Dietetics, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - H A Schuring
- Department of Dietetics, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - A Al-Mamgani
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - N M de Roos
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| |
Collapse
|
50
|
Swallowing outcomes and PEG dependence in head and neck cancer patients receiving definitive or adjuvant radiotherapy +/− chemotherapy with a proactive PEG: A prospective study with long term follow up. Oral Oncol 2015; 51:622-8. [DOI: 10.1016/j.oraloncology.2015.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 03/14/2015] [Accepted: 03/18/2015] [Indexed: 11/30/2022]
|